MED SURG 201 FINAL EXAM
FINAL EXAM QUESTIONS, ANSWERS
(EXPLAINED)
4. A patient who was admitted to the hospital with hyperglycemia and
newly diagnosed diabetesmellitus is scheduled for discharge the
second day after admission. When implementing patient teaching,
what is the priority action forthe nurse?
• Instruct about the increased risk for cardiovascular disease.
• Provide detailed information about dietary control of glucose.
• Teach glucose self-monitoring and medication administration.
• Give information about the effects of
exercise on glucose control.ANS: C
When time is limited, the nurse should focus on the priorities of
teaching. In this situation, the patient should know how to test blood
glucose and administer medications to control glucose levels. The
patient will need further teaching about the role of diet, exercise,
various medications, and the many potential complications of
diabetes, but these topics can be addressed through planning for
appropriate referrals.
• A 75-year-old patient is admitted for pancreatitis. Which tool
would be the most appropriatefor the nurse to use during the
admission assessment?
• Drug Abuse Screening Test (DAST-10)
• Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)
• Screening Test-Geriatric Version (SMAST-G)
• Mini-
Mental
State
Examinatio
n ANS: C
Because the abuse of alcohol is a common factor associated with the
development of pancreatitis, the first assessment step is to screen for
alcohol use using a validated screening questionnaire. The SMAST-G
is a short-form alcoholism screening instrument tailored specifically
to the needs of the older adult. If the patient scores positively on the
SMAST-G, thenthe CIWA-Ar would be a useful tool for determining
treatment. The DAST-10 provides more general information regarding
substance use. The Mini-Mental State Examination is used to screen
for cognitive impairment.
1|Page
,1. The sister of a patient diagnosed with BRCA gene–related breast
cancer asks the nurse, “Doyou think I should be tested for the
gene?” Which response by the nurse is most appropriate?
• “In most cases, breast cancer is not caused by the BRCA gene.”
• “It depends on how you will feel if the test is positive for the BRCA gene.”
• “There are many things to consider before deciding to have genetic testing.”
• “You should decide first whether you are willing to
have a bilateral mastectomy.”ANS: C
Although presymptomatic testing for genetic disorders allows
patients to take action (such as mastectomy) to prevent the
development of some genetically caused disorders, patients also
needto consider that test results in their medical record may affect
insurance, employability, etc.
Telling a patient that a decision about mastectomy should be made
before testing implies that thenurse has made a judgment about what
the patient should do if the test is positive. Although the patient may
need to think about her reaction if the test is positive, other issues
(e.g., insurance) also should be considered. Although most breast
cancers are not related to BRCA gene mutations,the patient with a
BRCA gene mutation has a markedly increased risk for breast
cancer.
7. The nurse in the outpatient clinic has obtained health histories
for these new patients. Whichpatient may need referral for genetic
testing?
• 35-year-old patient whose maternal grandparents died after strokes at ages 90 and
96
• 18-year-old patient with a positive pregnancy test whose first child has
cerebral palsy
• 34-year-old patient who has a sibling with newly diagnosed polycystic
kidney disease
• 50-year-old patient with a history of cigarette smoking
who is complaining of dyspneaANS: C
The adult form of polycystic kidney disease is an autosomal dominant
disorder and frequently it is
asymptomatic until the patient is older. Presymptomatic testing will
give the patient information thatwill be useful in guiding lifestyle and
childbearing choices. The other patients do not have any indication of
genetic disorders or need for genetic testing.
• An adolescent patient seeks care in the emergency department
after sharing needles forheroin injection with a friend who has
hepatitis B. To provide immediate protection from infection, what
medication will the nurse administer?
• Corticosteroids
• Gamma globulin
• Hepatitis B vaccine
2|Page
, • F
resh
froz
en
plas
ma
ANS
:B
The patient should first receive antibodies for hepatitis B from
injection of gamma globulin. The hepatitis B vaccination series should
be started to provide active immunity. Fresh frozen plasma and
corticosteroids will not be effective in preventing hepatitis B in the
patient.
6. A patient who is diagnosed with cervical cancer that is classified as
Tis, N0, M0 asks the nursewhat the letters and numbers mean. Which
response by the nurse is most appropriate?
• “The cancer involves only the cervix.”
• “The cancer cells look almost like normal cells.”
• “Further testing is needed to determine the spread of the cancer.”
• “It is difficult to determine the original
site of the cervical cancer.”ANS: A
Cancer in situ indicates that the cancer is localized to the cervix and
is not invasive at this time. Cell differentiation is not indicated by
clinical staging. Because the cancer is in situ, the origin isthe cervix.
Further testing is not indicated given that the cancer has not spread.
• External-beam radiation is planned for a patient with cervical cancer.
What instructions should thenurse give to the patient to prevent
complications from the effects of the radiation?
• Test all stools for the presence of blood.
• Maintain a high-residue, high-fiber diet.
• Clean the perianal area carefully after every bowel movement.
• Inspect the mouth and throat daily for
the appearance of thrush.ANS: C
Radiation to the abdomen will affect organs in the radiation path, such as the
bowel, and cause frequentdiarrhea. Careful cleaning of this area will help
decrease the risk for skin breakdown and infection.
Stools are likely to have occult blood from the inflammation associated with
radiation, so routine testingof stools for blood is not indicated. Radiation to
the abdomen will not cause stomatitis. A low-residue diet is recommended to
avoid irritation of the bowel when patients receive abdominal radiation.
3|Page
, • The nurse notes that a patient who was admitted with
diabetic ketoacidosis has rapid, deeprespirations. Which action
should the nurse take?
• Give the prescribed PRN lorazepam (Ativan).
• Start the prescribed PRN oxygen at 2 to 4 L/min.
• Administer the prescribed normal saline bolus and insulin.
• Encourage the patient to take deep, slow
breaths with guided imagery.ANS: C
The rapid, deep (Kussmaul) respirations indicate a metabolic acidosis and the
need for correction of the acidosis with a saline bolus to prevent hypovolemia
followed by insulin administration to allow glucose toreenter the cells. Oxygen
therapy is not indicated because there is no indication that the increased
respiratory rate is related to hypoxemia. The respiratory pattern is
compensatory, and the patient will not be able to slow the respiratory rate.
Lorazepam administration will slow the respiratory rate and increase the level
of acidosis.
• The nurse is caring for a patient who has a calcium level of
12.1 mg/dL. Which nursingaction should the nurse include on the
care plan?
• Maintain the patient on bed rest.
• Auscultate lung sounds every 4 hours.
• Monitor for Trousseau’s and Chvostek’s signs.
• Encourage fluid intake up
to 4000 mL every day.ANS: D
To decrease the risk for renal calculi, the patient should have a fluid intake of
3000 to 4000 mL daily. Ambulation helps decrease the loss of calcium from
bone and is encouraged in patients with hypercalcemia. Trousseau’s and
Chvostek’s signs are monitored when there is a possibility of hypocalcemia.
There is no indication that the patient needs frequent assessment of lung
sounds, althoughthese would be assessed every shift.
• A patient who had a transverse colectomy for diverticulosis 18 hours ago
has nasogastric suction and is complaining of anxiety and incisional pain.
The patient’s respiratory rate is 32 breaths/minute and the arterial blood
gases (ABGs) indicate respiratory alkalosis. Which action should the nurse
take first?
• Discontinue the nasogastric suction.
• Give the patient the PRN IV morphine sulfate 4 mg.
• Notify the health care provider about the ABG results.
• Teach the patient how to take slow,
deep breaths when anxious.ANS: B
The patient’s respiratory alkalosis is caused by the increased respiratory
rate associated with pain and anxiety. The nurse’s first action should be to
medicate the patient for pain. Although the nasogastric suction may
contribute to the alkalosis, it is not appropriate to discontinue the tube when
the patient needsgastric suction. The health care provider may be notified
about the ABGs but is likely to instruct the nurse to medicate for pain. The
patient will not be able to take slow, deep breaths when experiencing pain.
4|Page
FINAL EXAM QUESTIONS, ANSWERS
(EXPLAINED)
4. A patient who was admitted to the hospital with hyperglycemia and
newly diagnosed diabetesmellitus is scheduled for discharge the
second day after admission. When implementing patient teaching,
what is the priority action forthe nurse?
• Instruct about the increased risk for cardiovascular disease.
• Provide detailed information about dietary control of glucose.
• Teach glucose self-monitoring and medication administration.
• Give information about the effects of
exercise on glucose control.ANS: C
When time is limited, the nurse should focus on the priorities of
teaching. In this situation, the patient should know how to test blood
glucose and administer medications to control glucose levels. The
patient will need further teaching about the role of diet, exercise,
various medications, and the many potential complications of
diabetes, but these topics can be addressed through planning for
appropriate referrals.
• A 75-year-old patient is admitted for pancreatitis. Which tool
would be the most appropriatefor the nurse to use during the
admission assessment?
• Drug Abuse Screening Test (DAST-10)
• Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)
• Screening Test-Geriatric Version (SMAST-G)
• Mini-
Mental
State
Examinatio
n ANS: C
Because the abuse of alcohol is a common factor associated with the
development of pancreatitis, the first assessment step is to screen for
alcohol use using a validated screening questionnaire. The SMAST-G
is a short-form alcoholism screening instrument tailored specifically
to the needs of the older adult. If the patient scores positively on the
SMAST-G, thenthe CIWA-Ar would be a useful tool for determining
treatment. The DAST-10 provides more general information regarding
substance use. The Mini-Mental State Examination is used to screen
for cognitive impairment.
1|Page
,1. The sister of a patient diagnosed with BRCA gene–related breast
cancer asks the nurse, “Doyou think I should be tested for the
gene?” Which response by the nurse is most appropriate?
• “In most cases, breast cancer is not caused by the BRCA gene.”
• “It depends on how you will feel if the test is positive for the BRCA gene.”
• “There are many things to consider before deciding to have genetic testing.”
• “You should decide first whether you are willing to
have a bilateral mastectomy.”ANS: C
Although presymptomatic testing for genetic disorders allows
patients to take action (such as mastectomy) to prevent the
development of some genetically caused disorders, patients also
needto consider that test results in their medical record may affect
insurance, employability, etc.
Telling a patient that a decision about mastectomy should be made
before testing implies that thenurse has made a judgment about what
the patient should do if the test is positive. Although the patient may
need to think about her reaction if the test is positive, other issues
(e.g., insurance) also should be considered. Although most breast
cancers are not related to BRCA gene mutations,the patient with a
BRCA gene mutation has a markedly increased risk for breast
cancer.
7. The nurse in the outpatient clinic has obtained health histories
for these new patients. Whichpatient may need referral for genetic
testing?
• 35-year-old patient whose maternal grandparents died after strokes at ages 90 and
96
• 18-year-old patient with a positive pregnancy test whose first child has
cerebral palsy
• 34-year-old patient who has a sibling with newly diagnosed polycystic
kidney disease
• 50-year-old patient with a history of cigarette smoking
who is complaining of dyspneaANS: C
The adult form of polycystic kidney disease is an autosomal dominant
disorder and frequently it is
asymptomatic until the patient is older. Presymptomatic testing will
give the patient information thatwill be useful in guiding lifestyle and
childbearing choices. The other patients do not have any indication of
genetic disorders or need for genetic testing.
• An adolescent patient seeks care in the emergency department
after sharing needles forheroin injection with a friend who has
hepatitis B. To provide immediate protection from infection, what
medication will the nurse administer?
• Corticosteroids
• Gamma globulin
• Hepatitis B vaccine
2|Page
, • F
resh
froz
en
plas
ma
ANS
:B
The patient should first receive antibodies for hepatitis B from
injection of gamma globulin. The hepatitis B vaccination series should
be started to provide active immunity. Fresh frozen plasma and
corticosteroids will not be effective in preventing hepatitis B in the
patient.
6. A patient who is diagnosed with cervical cancer that is classified as
Tis, N0, M0 asks the nursewhat the letters and numbers mean. Which
response by the nurse is most appropriate?
• “The cancer involves only the cervix.”
• “The cancer cells look almost like normal cells.”
• “Further testing is needed to determine the spread of the cancer.”
• “It is difficult to determine the original
site of the cervical cancer.”ANS: A
Cancer in situ indicates that the cancer is localized to the cervix and
is not invasive at this time. Cell differentiation is not indicated by
clinical staging. Because the cancer is in situ, the origin isthe cervix.
Further testing is not indicated given that the cancer has not spread.
• External-beam radiation is planned for a patient with cervical cancer.
What instructions should thenurse give to the patient to prevent
complications from the effects of the radiation?
• Test all stools for the presence of blood.
• Maintain a high-residue, high-fiber diet.
• Clean the perianal area carefully after every bowel movement.
• Inspect the mouth and throat daily for
the appearance of thrush.ANS: C
Radiation to the abdomen will affect organs in the radiation path, such as the
bowel, and cause frequentdiarrhea. Careful cleaning of this area will help
decrease the risk for skin breakdown and infection.
Stools are likely to have occult blood from the inflammation associated with
radiation, so routine testingof stools for blood is not indicated. Radiation to
the abdomen will not cause stomatitis. A low-residue diet is recommended to
avoid irritation of the bowel when patients receive abdominal radiation.
3|Page
, • The nurse notes that a patient who was admitted with
diabetic ketoacidosis has rapid, deeprespirations. Which action
should the nurse take?
• Give the prescribed PRN lorazepam (Ativan).
• Start the prescribed PRN oxygen at 2 to 4 L/min.
• Administer the prescribed normal saline bolus and insulin.
• Encourage the patient to take deep, slow
breaths with guided imagery.ANS: C
The rapid, deep (Kussmaul) respirations indicate a metabolic acidosis and the
need for correction of the acidosis with a saline bolus to prevent hypovolemia
followed by insulin administration to allow glucose toreenter the cells. Oxygen
therapy is not indicated because there is no indication that the increased
respiratory rate is related to hypoxemia. The respiratory pattern is
compensatory, and the patient will not be able to slow the respiratory rate.
Lorazepam administration will slow the respiratory rate and increase the level
of acidosis.
• The nurse is caring for a patient who has a calcium level of
12.1 mg/dL. Which nursingaction should the nurse include on the
care plan?
• Maintain the patient on bed rest.
• Auscultate lung sounds every 4 hours.
• Monitor for Trousseau’s and Chvostek’s signs.
• Encourage fluid intake up
to 4000 mL every day.ANS: D
To decrease the risk for renal calculi, the patient should have a fluid intake of
3000 to 4000 mL daily. Ambulation helps decrease the loss of calcium from
bone and is encouraged in patients with hypercalcemia. Trousseau’s and
Chvostek’s signs are monitored when there is a possibility of hypocalcemia.
There is no indication that the patient needs frequent assessment of lung
sounds, althoughthese would be assessed every shift.
• A patient who had a transverse colectomy for diverticulosis 18 hours ago
has nasogastric suction and is complaining of anxiety and incisional pain.
The patient’s respiratory rate is 32 breaths/minute and the arterial blood
gases (ABGs) indicate respiratory alkalosis. Which action should the nurse
take first?
• Discontinue the nasogastric suction.
• Give the patient the PRN IV morphine sulfate 4 mg.
• Notify the health care provider about the ABG results.
• Teach the patient how to take slow,
deep breaths when anxious.ANS: B
The patient’s respiratory alkalosis is caused by the increased respiratory
rate associated with pain and anxiety. The nurse’s first action should be to
medicate the patient for pain. Although the nasogastric suction may
contribute to the alkalosis, it is not appropriate to discontinue the tube when
the patient needsgastric suction. The health care provider may be notified
about the ABGs but is likely to instruct the nurse to medicate for pain. The
patient will not be able to take slow, deep breaths when experiencing pain.
4|Page
